Talk:Abnormal Development - TORCH Infections

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Cite this page: Hill, M.A. (2021, May 9) Embryology Abnormal Development - TORCH Infections. Retrieved from


Seasonal influence on TORCH infection and analysis of multi-positive samples with indirect immunofluorescence assay

J Clin Lab Anal. 2019 May;33(4):e22828. doi: 10.1002/jcla.22828. Epub 2019 Jan 21.

Chen L1, Liu J1, Shi L2, Song Y1, Song Y1, Gao Y1, Dong Y1, Li L3, Shen M4, Zhai Y1, Cao Z1.

BACKGROUND: TORCH including the pathogens of Toxoplasma gondii (TOX), rubella virus (RV), cytomegalovirus (CMV), and herpes simplex virus (HSV) causes intrauterine infections and poses a worldwide threat to women especially in pregnancy. In this study, we described the seasonal difference in TORCH infection and analyzed the anti-TORCH IgM multipositive serum samples by the indirect immunofluorescence assays (IFA). METHODS: To observe the seasonal influence of the anti-TORCH IgG and IgM antibodies, a retrospective study was conducted with 10 669 women (20-40 y old) before pregnancy from August 2016 to July 2017. Totally 199 ELISA anti-TORCH IgM multipositive serum samples were further tested by IFAs for false-positive analysis. RESULTS: The prevalence of positive HSV1-IgM, RV-IgM, HSV2-IgM, CMV-IgM, and TOX-IgM in the present population was 6.30%, 2.55%, 1.94%, 1.24%, and 0.67%, respectively. Additionally, the prevalence of positive RV-IgM, CMV-IgM, and HSV1-IgM was statistically different among four seasons, with the highest positive rates of RV-IgM (4.12%) in autumn, CMV-IgM (1.75%) in summer, and HSV1-IgM (7.53%) in winter. The confirmatory IFAs showed that the positive rates of RUV-IgM, CMV-IgM, and HSV2-IgM were significantly different from those in ELISA screening experiments. Interestingly, only 32.7% (65/199) of the TORCH IgM multipositive results were consistent with those by the IFA, indicating that cross-reaction caused false positives were common in ELISA IgM antibody screening. CONCLUSION: The TORCH infection displayed different prevalence among four seasons in our 12-month retrospective study. The IgM multipositives by ELISA screening may need further confirmation analysis due to its relatively high cross-reaction rate. © 2018 The Authors Journal of Clinical Laboratory Analysis Published by Wiley Periodicals, Inc. KEYWORDS: IFA; TORCH; multipositive; prevalence; season PMID: 30666721 DOI: 10.1002/jcla.22828


TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea

Korean J Pediatr. 2018 Apr;61(4):114-120. doi: 10.3345/kjp.2018.61.4.114. Epub 2018 Apr 23.

Chung MH1, Shin CO1, Lee J1.

PURPOSE: Routine screening for toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (TORCH) in intrauterine growth restriction (IUGR) and small for gestational age (SGA) neonates has become a common practice. However, the incidence of TORCH varies across countries, and the cost of TORCH testing may be disadvantageous compared to disease-specific screening. To evaluate the efficacy of TORCH screening, the medical charts of IUGR or SGA neonates born in a single institution in Bucheon, Korea from 2011 to 2015 were reviewed. METHODS: The clinical data of the 126 IUGR or SGA neonates were gathered, including gestational age, Apgar scores, neonatal sonographic findings, chromosome study, morbidities, developmental follow-up, and growth catch-up. Maternal factors including underlying maternal disease and fetal sonography were collected, and placental findings were recorded when available. TORCH screening was done using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis. Tests were repeated only for those with positive results. RESULTS: Of the 119 TORCH screenings, only one was positive for toxoplasmosis IgM. This result was deemed false positive due to negative IgM on repeated testing and the absence of clinical symptoms. CONCLUSION: Considering the incidence and risk of TORCH in Korea, the financial burden of TORCH screening, and the single positive TORCH finding in our study, we suggest disease-specific screening based on maternal history and the clinical symptoms of the neonate. Regarding CMV, which may present asymptomatically, universal screening may be appropriate upon cost-benefit analysis. KEYWORDS: Intrauterine growth retardation; Small for gestational age; TORCH PMID: 29713357 PMCID: PMC5924842 DOI: 10.3345/kjp.2018.61.4.114

Infections During Pregnancy

Prim Care. 2018 Sep;45(3):567-586. doi: 10.1016/j.pop.2018.05.013. Epub 2018 Jul 9.

Leeper C1, Lutzkanin A 3rd2.

Abstract Several infections have unique consequences or considerations in pregnancy. Some common infections such as urinary tract infections, influenza, sexually transmitted diseases, and vaginitis affect pregnant women differently than the general population, can cause pregnancy complications, and require treatments that are safe in pregnancy. Infections such as hepatitis B and C and human immunodeficiency virus can be transmitted vertically and therefore management focuses on decreasing perinatal transmission. Certain infections can be transmitted in utero and cause congenital infections. Classically, these were grouped together as the TORCH infections, although now several others, including varicella virus, parvovirus, and Zika virus, have also been recognized. KEYWORDS: Congenital infection; Pregnancy complications; TORCH; Vertical transmission; Zika PMID: 30115342 DOI: 10.1016/j.pop.2018.05.013

Defense and infection of the human placenta

APMIS. 2018 Jul;126(7):570-588. doi: 10.1111/apm.12847.

Heerema-McKenney A1.

Abstract The placenta functions as a shield against infection of the fetus. The innate and adaptive immune defenses of the developing fetus are poorly equipped to fight infections. Infection by bacteria, viruses, and protozoa may cause infertility, spontaneous abortion, stillbirth, growth retardation, anomalies of development, premature delivery, neonatal morbidity, and mortality. However, appreciation of the human microbiome and host cell-microbe interactions must be taken into consideration as we try to determine what interactions are pathologic. Infection is typically recognized histologically by the presence of inflammation. Yet, several factors make comparison of the placenta to other human organs difficult. The placenta comprises tissues from two persons, complicating the role of the immune system. The placenta is a temporary organ. It must be eventually expelled; the processes leading to partuition involve maternal inflammation. What is normal or pathologic may be a function of timing or extent of the process. We now must consider whether bacteria, and even some viruses, are useful commensals or pathogens. Still, recognizing infection of the placenta is one of the most important contributions placental pathologic examination can give to care of the mother and neonate. This review provides a brief overview of placental defense against infection, consideration of the placental microbiome, routes of infection, and the histopathology of amniotic fluid infection and TORCH infections. KEYWORDS: Congenital infection; pathology; placenta; surgical pathology; vertical transmission PMID: 30129129 DOI: 10.1111/apm.12847


Awareness of and knowledge about mother-to-child infections in Japanese pregnant women

Congenit Anom (Kyoto). 2014 Feb;54(1):35-40. doi: 10.1111/cga.12030.

Morioka I1, Sonoyama A, Tairaku S, Ebina Y, Nagamata S, Morizane M, Tanimura K, Iijima K, Yamada H.


To reduce the incidence of infants with congenital infections, women should be aware of and know prevention measures against maternal infection with mother-to-child infections during pregnancy. Our objective was to assess the awareness of and knowledge about mother-to-child infections in Japanese pregnant women. A survey of 343 Japanese pregnant women was completed. Awareness of 13 pathogens capable of mother-to-child transmission was surveyed. Knowledge about the transmission route, the most susceptible time of infection that may cause severe fetal disease during pregnancy, and methods to prevent maternal infection were investigated for four major pathogens (cytomegalovirus, rubella virus, Toxoplasma gondii, and parvovirus B19) and results were compared between these pathogens. The proportion of women aware of pathogens concerning TORCH syndrome was the following: rubella virus 76%, Treponema pallidum 69%, Toxoplasma gondii 58%, parvovirus B19 28%, herpes simplex virus 27%, and cytomegalovirus 18%. Only 8% knew how cytomegalovirus is transmitted, and only 12% knew how parvovirus B19 is transmitted; both were significantly lower than those who knew transmission routes for rubella virus or Toxoplasma gondii. The proportion of women who knew the most susceptible time for severe fetal infection by maternal acquisition of cytomegalovirus, Toxoplasma gondii, or parvovirus B19 was significantly lower than that for rubella virus. The vast majority of surveyed women were not aware of methods to prevent maternal infection with cytomegalovirus or parvovirus B19. In conclusion, current awareness of and knowledge about cytomegalovirus and parvovirus B19 infection are low in Japanese pregnant women. © 2013 The Authors. Congenital Anomalies © 2013 Japanese Teratology Society. KEYWORDS: Toxoplasma gondii; cytomegalovirus; parvovirus B19; pregnant women; rubella virus

PMID 24588778


Gastrointestinal presentation and outcome of perinatal cytomegalovirus infection

BMJ Case Rep. 2013 Jan 4;2013. pii: bcr2012007671. doi: 10.1136/bcr-2012-007671.

Hendriks G, McPartland J, El-Matary W. Source Gastroenterology Department, Alder Hey Children's Hospital, Liverpool, UK.


A term infant presented at birth with bilious vomiting and abdominal distension. Multiple investigations were undertaken, including two laparotomies and a rectal biopsy, as no obvious cause for his symptoms could be found. This included testing for human cytomegalovirus (CMV) infection as part of a TORCH screen, which was negative at 10 days of age. However, a repeat screen at 3 weeks of age demonstrated positive findings of CMV in both urine and blood PCR. This subsequently led to the diagnosis of gastrointestinal pseudoobstruction associated with perinatal CMV infection. This case is of interest though there is limited information regarding the recognition of gastrointestinal symptoms in relation to CMV infection. This report aims to highlight our experience with an infant with perinatal CMV infection and severe gastrointestinal symptoms.

PMID: 23291921


Prevalence of Serum Antibodies to TORCH Infection in and Around Varanasi, Northern India

J Clin Diagn Res. 2012 Nov;6(9):1483-5. doi: 10.7860/JCDR/2012/4550.2538.

Sen MR, Shukla BN, Tuhina B. Source Professor, Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005, UP, India. Abstract BACKGROUND: The acute infections which are caused by Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV) and the Herpes Simplex Virus (HSV-2) during pregnancy are often associated with adverse foetal outcomes and reproductive failures. In the Indian context, the exact seroprevalence of these infections is not known due to unavailability of baseline data. AIMS: The present study was undertaken to determine the serological evidence of the acute TORCH infections in women who were in the first trimesters of their pregnancies in and around Varanasi, north India. SETTINGS AND DESIGN: This study was carried out in the Sir Sunderlal Hospital, Varanasi and in the Department of Microbiology, Institute of Medical Sciences, BHU, Varanasi, UP, India. The study population involved pregnant women with bad obstetric histories, who were in the first trimester of their pregnancy. METHODS AND MATERIALS: Sera were collected from the women with Bon and they were tested for the presence of specific IgM antibodies against the TORCH infections by ELISA. STATISTICAL ANALYSIS: A 95% confidence interval was calculated for the positive cases in each of the TORCH components. RESULTS: The specific IgM antibodies were found to be positive in 74(19.4%) cases for toxoplasmosis, in 126 (30.4%) cases for the Rubella virus, in 130 (34.7%) cases for CMV and in 151 samples (33.5%) for the HSV-2 infections. CONCLUSIONS: The study showed a high prevalence of the infections which were caused by the TORCH complex amongst pregnant women with bad obstetric histories. Therefore, all the antenatal cases should be routinely screened for the TORCH infections, for carrying out early interventions to prevent foetal loss.

PMID 23285435

Significance of maternal screening for toxoplasmosis, rubella, cytomegalovirus and herpes simplex virus infection in cases of fetal growth restriction

J Obstet Gynaecol Res. 2012 Oct 29. doi: 10.1111/j.1447-0756.2012.02012.x. [Epub ahead of print]

Yamamoto R, Ishii K, Shimada M, Hayashi S, Hidaka N, Nakayama M, Mitsuda N. Source Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.

Abstract AIM: The objective of this study was to evaluate the significance of maternal toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (TORCH) screening in cases of fetal growth restriction (FGR). MATERIAL AND METHODS: The medical records of women carrying fetuses with FGR who underwent TORCH screening over a 10-year period were retrospectively reviewed for maternal and congenital TORCH infection. Women carrying fetuses with FGR routinely underwent serologic TORCH tests and systematic ultrasound evaluation for congenital abnormalities. If a congenital CMV infection was suspected, amniotic fluid, placenta or neonatal urine was used for CMV DNA detection by polymerase chain reaction. RESULTS: In 319 patients, no cases of maternal or congenital infection with toxoplasma, rubella, or herpes simplex virus were found. Conversely, six cases (1.8%) were diagnosed with congenital CMV infection, two of which had no structural abnormalities other than FGR. CONCLUSIONS: A complete maternal TORCH screening for cases of FGR appears to be unnecessary. Although a maternal CMV test can be considered, the incidence of congenital CMV infection was found to be low in FGR cases. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

PMID 23107457


Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review

BMC Public Health. 2011 Apr 13;11 Suppl 3:S3. doi: 10.1186/1471-2458-11-S3-S3.

Ishaque S, Yakoob MY, Imdad A, Goldenberg RL, Eisele TP, Bhutta ZA. Source Division of Women and Child Health, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. Abstract BACKGROUND: Infection is a well acknowledged cause of stillbirths and may account for about half of all perinatal deaths today, especially in developing countries. This review presents the impact of interventions targeting various important infections during pregnancy on stillbirth or perinatal mortality. METHODS: We undertook a systematic review including all relevant literature on interventions dealing with infections during pregnancy for assessment of effects on stillbirths or perinatal mortality. The quality of the evidence was assessed using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach by Child Health Epidemiology Reference Group (CHERG). For the outcome of interest, namely stillbirth, we applied the rules developed by CHERG to recommend a final estimate for reduction in stillbirth for input to the Lives Saved Tool (LiST) model. RESULTS: A total of 25 studies were included in the review. A random-effects meta-analysis of observational studies of detection and treatment of syphilis during pregnancy showed a significant 80% reduction in stillbirths [Relative risk (RR) = 0.20; 95% confidence interval (CI): 0.12 - 0.34) that is recommended for inclusion in the LiST model. Our meta-analysis showed the malaria prevention interventions i.e. intermittent preventive treatment (IPTp) and insecticide-treated mosquito nets (ITNs) can reduce stillbirths by 22%, however results were not statistically significant (RR = 0.78; 95% CI: 0.59 - 1.03). For human immunodeficiency virus infection, a pooled analysis of 6 randomized controlled trials (RCTs) failed to show a statistically significant reduction in stillbirth with the use of antiretroviral in pregnancy compared to placebo (RR = 0.93; 95% CI: 0.45 - 1.92). Similarly, pooled analysis combining four studies for the treatment of bacterial vaginosis (3 for oral and 1 for vaginal antibiotic) failed to yield a significant impact on perinatal mortality (OR = 0.88; 95% CI: 0.50 - 1.55). CONCLUSIONS: The clearest evidence of impact in stillbirth reduction was found for adequate prevention and treatment of syphilis infection and possibly malaria. At present, large gaps exist in the growing list of stillbirth risk factors, especially those that are infection related. Potential causes of stillbirths including HIV and TORCH infections need to be investigated further to help establish the role of prevention/treatment and its subsequent impact on stillbirth reduction.

PMID 21501448